Disruptions in the development of feeding for infants with congenital heart disease.

Congenital heart disease (CHD) is the most common birth defect for infants born in the United States, with approximately 36,000 affected infants born annually. While mortality rates for children with CHD have significantly declined, there is a growing population of individuals with CHD living into adulthood prompting the need to optimise long-term development and quality of life. For infants with CHD, pre- and post-surgery, there is an increased risk of developmental challenges and feeding difficulties. Feeding challenges carry profound implications for the quality of life for individuals with CHD and their families as they impact short- and long-term neurodevelopment related to growth and nutrition, sensory regulation, and social-emotional bonding with parents and other caregivers. Oral feeding challenges in children with CHD are often the result of medical complications, delayed transition to oral feeding, reduced stamina, oral feeding refusal, developmental delay, and consequences of the overwhelming intensive care unit (ICU) environment. This article aims to characterise the disruptions in feeding development for infants with CHD and describe neurodevelopmental factors that may contribute to short- and long-term oral feeding difficulties.

Evaluating dysphagia in infants with congenital heart disease using Fiberoptic Endoscopic Evaluation of Swallowing.

OBJECTIVE: Dysphagia is common in infants with congenital heart disease (CHD). However, there is minimal published data regarding its management outside of the perioperative period. The objective of this study is to describe the role of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in the diagnosis and management of dysphagia in infants with CHD. METHODS: Infants with CHD who underwent FEES exam for evaluation of swallowing dysfunction between February 2015 and February 2021 at a university-based, tertiary care urban pediatric hospital were studied. Demographic data, presenting symptoms, medical history, and dysphagia history were examined. The validated Dysphagia Outcome and Severity Scale (DOSS) was used to standardize and compare dysphagia severity. RESULTS: 62 FEES exams were performed on 48 patients. All 48 patients were diagnosed with dysphagia and had a mean dysphagia severity score (DOSS) of 2.68. Patients with wet laryngeal congestion on presentation had worse mean DOSS score and were more likely to demonstrate aspiration on FEES exam (p < 0.01). There was no significant difference in mean DOSS or presence of aspiration when comparing infants who had cardiothoracic surgery, vocal cord paralysis, or lower respiratory tract illness with those who had not (p > 0.05). CONCLUSION: A FEES exam is an effective and well-tolerated procedure for evaluating swallowing dysfunction in pediatric patients with CHD and its use reduces radiation exposure for this vulnerable population. Wet laryngeal congestion was found to be predictive of more severe dysphagia and aspiration. There is no significant association between severity of dysphagia or aspiration on FEES exam and history of cardiac surgery, vocal cord paralysis, or lower respiratory tract illness.

Fiberoptic examination of swallowing in the breastfeeding infant.

OBJECTIVES/HYPOTHESIS: Fiberoptic endoscopic evaluation of swallowing (FEES) is the only instrumental exam that can be used to assess swallowing in a breastfeeding infant. There is minimal data on its efficacy and safety in this patient population. Analyze the common indications for, findings of, and safety of FEES exam in breastfeeding infants. STUDY DESIGN: Case series. METHODS: Consecutive 10 months old or younger breastfed infants undergoing a FEES exam between June 1, 2012, and August 1, 2014, at a university-based, tertiary care urban children's hospital were studied. Common indications for and findings of FEES, as well as complications of the procedure, were determined. RESULTS: Twenty-four FEES were reviewed on 23 patients. There were 14 males (58%). The average age was 14 weeks, and two children were premature. Common indications for FEES were feeding difficulties (52%), noisy breathing with/without feeding (28%), and cyanosis (16%). Of the patients who participated in active breastfeeding during the exam, a functional swallow was identified in 12.5%. The remaining patients demonstrated dysphagia characterized by laryngeal penetration (83%) and/or direct aspiration (50%). The most common findings were laryngeal edema (29%), anterior displacement of glottis structures (14%), and cobblestoning (11%). There was no morbidity directly associated with the procedure. No cyanosis or respiratory distress occurred during or immediately after the procedure. CONCLUSION: Performing FEES exams on breastfeeding infants is safe and effective. There is no other instrumental evaluation of swallowing to assess dysphagia in this population. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1681-1686, 2016.